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Post-Operative Fever Workup in Pediatric Neurosurgery Patients

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Post-Operative Fever Workup in Pediatric Neurosurgery Patients 43rd Annual Meeting The American Society of Pediatric Neurosurgeons Jointly provided by AANS Post-Operative Fever Workup in Pediatric Neurosurgery Patients Raviv, N 1, Field, N1, Adamo, MA1 1 Neurosurgery, Albany Medical Center, Albany, (New York) USA Introduction Fevers are common in the post-operative period, and literature indicates that workup for isolated fever is not warranted in the first two to four postoperative days. We sought to determine both the incidence of acute fever, and to assess the utility of performing further workup in the post-operative neurosurgical patients Methods A single-institution, retrospective study was performed examining patients age </=18 years with craniosynostosis, Chiari malformation, and brain tumors from 2009-2018. Fevers defined as a temperature≥38.0°C were identified during the first four post-operative days. Charts were queried for urinalysis/culture (UA/Ucx), chest radiographs (CXR), blood cultures (Bcx), cerebral spinal fluid culture (CSFcx), viral panel, white cell count (WBC), transfusion history, development of wound infection, and placement of ventricular(EVD) and lumbar drains(LD). 30- day post-operative microbiology results and readmissions were reviewed. Descriptive statistics were performed using logistic regression analysis with IBM SPSS Statistics for Mac, version 25. Results 235 patients were evaluated, and 61% developed fevers within the first four post-operative days. 26.5%(38/143) of febrile patients underwent further workup, and patients with fevers >39.0°C were more likely to undergo further evaluation, most commonly including UA/Ucx(21.7%). 1%(2/143) of patients were found to have infection during the first 4 days, and 7 additional patients(6 with acute post-operative fevers) developed infection following the initial 4 days and within the first 30 post-operative days. Iinfectious complications were not found to correlate with acute post-operative fevers(p<0.120); however, multiple days of acute post-operative fevers (p<0.034) and the presence of EVDs(p<0.001) were found to be associated with development of an infectious complication within 30-days. Acute post-operative fevers were associated with EVD(p<0.038), as well as blood product transfusions and an increased WBC count(p<0.001). Conclusions Isolated fevers within the first four post-operative days are rarely associated with infectious etiology. Additional factors should be considered when deciding to pursue further investigation. Unauthenticated | Downloaded 09/28/21 05:26 AM UTC 43rd Annual Meeting The American Society of Pediatric Neurosurgeons Jointly provided by AANS Optical Coherence Tomography Can Detect Elevated Intracranial Pressure in Craniosynostosis Shih-Shan Lang MD1, Christopher Kalmar MD2, Gregory Heuer MD, PhD1, Scott Bartlett MD2, Laura Humphries MD2, Phillip Storm MD1, Jesse Taylor MD2, Jordan Swanson MD2 1 Division of Neurosurgery, Children’s Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania 2 Division of Plastic & Reconstructive Surgery, Children’s Hospital of Philadelphia, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania Background Identifying elevated intracranial pressure (ICP) in patients with craniosynostosis may facilitate appropriate intervention in order to prevent neurocognitive impairments. Noninvasive spectral- domain optical coherence tomography (OCT) of the retina has demonstrated high sensitivity and specificity for detecting ICP. This study aimed to characterize patterns of elevated ICP among patients with craniosynostosis. Methods Quantitative retinal parameters using spectral-domain OCT were prospectively assessed bilaterally in patients with craniosynostosis. Subjects were considered to have elevated ICP if the invasive measurement was ≥15mmHg. The threshold for retinal parameters equating to elevated ICP was retinal nerve fiber layer maximal thickness >208 microns or maximal retinal inner projection >159 microns in either eye based on 95% CI of normal subjects. Univariate and multivariate analysis of OCT findings and type of craniosynostosis was performed. Results One hundred thirty-three subjects (age median 12.5 months, age range 1.0-205.3 months) with craniosynostosis were enrolled at the time of initial cranial vault expansion. Of these patients, 69.2% (n=92 of 133 patients) had invasive ICP measurement intraoperatively and 80.4% (n=74 of 92 patients) were nonsyndromic. There was a significant association between having elevated ICP based on suture involvement (p=.047). Patients were more likely to have elevated ICP with unicoronal (57.1%, n=4 of 7), sagittal (51.4%, n=18 of 35), bicoronal (100.0%, n=2 of 2), and multisuture involvement (100%, n=5 of 5). Patients were more likely to have non-elevated ICP with metopic (68.2%, n=15 of 22) and lambdoid (66.7%, n=2 of 3) synostosis. OCT demonstrated a sensitivity of 88% (95% CI 69%-96%) and specificity of 67% (95% CI 48-81%). Unauthenticated | Downloaded 09/28/21 05:26 AM UTC 43rd Annual Meeting The American Society of Pediatric Neurosurgeons Jointly provided by AANS Conclusions OCT of the retina is a potentially sensitive and specific indicator of elevated ICP in craniosynostosis patients with normal fundoscopic exams and shows promise as a noninvasive diagnostic modality. Moreover, type of suture involved demonstrated significant association with predicting elevated ICP in nonsyndromic patients. Unauthenticated | Downloaded 09/28/21 05:26 AM UTC 43rd Annual Meeting The American Society of Pediatric Neurosurgeons Jointly provided by AANS Abstract #4: Predictive Factors for Definitive CSF Diversion in Post-hemorrhagic Hydrocephalus Ramin Eskandari1,2, Thomas Larrew1, Tyler Vasas1 1Department of Neurosurgery, Medical University of South Carolina, Charleston SC USA 2Department of Pediatrics, Medical University of South Carolina, Charleston, SC USA Background Post-hemorrhagic hydrocephalus (PHH) portends devastating outcomes in many preterm infants. Recent studies demonstrate a link between earlier intervention, smaller ventricles and haste for intraventricular hemorrhage removal to correlate with improved outcomes. We describe our use of early and aggressive reservoir intervention with a prolonged weaning period prior and how they correlate with CSF shunting. Methods 34 Consecutive PHH infants with reservoirs between January 2016 and February, 2019 were evaluated. 26 patients met inclusion and underwent evaluation including multiple ventricular measurements, head circumference, weight, age and timing of reservoir placement among many other parameters to investigate the link between those weaned versus unweaned from reservoir tapping requiring CSF shunting. Standard tapping = 10ml/kg/day. Shunting was offered at ≥2.5kg. Weaning was initiated at ≥38weeks gestation. Results Six patients were successfully weaned (follow-up 18-36 months). At last follow-up, 19 of 20 patients required ventriculoperitoneal shunting (VPS) (6-42 months). Birth weight (BW) and gestational age (GA) were higher in weaned patients (p=0.03). 3rd ventricle (3rdV) and biventricular diameter (BVD) at 2.5kg demonstrated weaning associations. Average BVD measured 31.4mm and 40.6mm in weaned versus unweaned respectively (p=0.01). At 2.5kg, the 3rdV measured 6 mm and 8.2mm in weaned versus unweaned (p=0.03). Five of 6 weaned patients underwent prolonged tapping past shunting weight of 2.5kg. Conclusions Our small retrospective cohort demonstrates statistically significant differences in several factors in PHH newborns requiring shunting versus those successfully weaned. Although birth weight and age are important indicators of disease severity, ventricular size at the time of decision making for CSF shunting was significantly different in those who eventually were weaned. Multi- center cohorts with this aggressive and prolonged tapping/weaning protocol may establish predictive value of these metrics. These data also suggest a potential link between prolonged aggressive tapping and ultimate need for CSF diversion surgery. Author Disclosures Ramin Eskandari has received compensation for consulting work from Anuncia Inc. – unrelated to this research Neither Thomas Larrew nor Tyler Vasas have any disclosures to report Unauthenticated | Downloaded 09/28/21 05:26 AM UTC 43rd Annual Meeting The American Society of Pediatric Neurosurgeons Jointly provided by AANS Short-term Functional Outcomes of Infra-Conus Mini-Laminotomy for Selective Dorsal Rhizotomy: A Surgical and Rehabilitative Perspective Neena I. Marupudi1,3, M.D., M.S., Lubna Ayoubi, B.S. 2,3, Melisa Concepcion, PA-C2,3, Charles Pelshaw, M.D.2,3, Erika Erlandson, M.D.2,3 1Department of Pediatric Neurosurgery, Children’s Hospital of Michigan, Detroit Medical Center 2Department of Pediatric Physical Medicine and Rehabilitation, Children’s Hospital of Michigan, Detroit Medical Center 3Wayne State University School of Medicine Background/Aims Selective dorsal rhizotomy (SDR) for the treatment of spasticity in children with cerebral palsy is an effective and well-validated surgical approach. While numerous techniques have been described in the past, including multiple level laminectomy and laminectomy at the conus, the infra-conus mini-laminectomy/laminotomy approach is another recently described approach. with advantages. Understanding the short-term effects on gross motor function and endurance postoperatively is necessary to prepare families and therapy staff
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